<!DOCTYPE html>
<html lang="en">
  <head>
    <meta charset="UTF-8" />
    <meta http-equiv="X-UA-Compatible" content="IE=edge" />
    <meta name="viewport" content="width=device-width, initial-scale=1.0" />
    <title>Document</title>
    <link rel="stylesheet" href="../css/InfectionCaseReportCard.css" />
  </head>
  <body>
    <div>
      <select name="" class="gr1-box">
        <option value="">感染病例报告卡</option>
        <option value="">医疗医技异常事件</option>
        <option value="">护理异常事件</option>
        <option value="">副输血不良反应高</option>
        <option value="">医疗器械异常事件</option>
        <option value="">药物不良反应事件 </option>
        <option value="">异常用药事件 </option>
        <option value="">行政与后勤保障事件 </option>
        <option value="">治安管理异常事件 </option>
     </select>
    </div>
    <div class="gr2">
      <div class="gr2-1"></div>
      <div class="gr2-2">
        <div class="gr2-2-top">
          <div class="top-left"></div>
          <h3>填报说明</h3>
        </div>
        <p>
          1.
          医院感染病例由报告人于24小时之内报告医院感染科。报告人必须是病人经治医师。
        </p>
        <p>
          2.
          医院感染管理科发现医院感染流行趋势，应于24小时之内报告主管院长和医务处
        </p>
        <p>
          3.
          医院调查证实出现医院感染流行或爆发时，应于24小时之内报告当地卫生行政部门。
        </p>
      </div>
    </div>
    <div class="gr3">
      <div></div>
      <span>感染病例报告填写</span>
    </div>
    <div class="gr4">
      <div class="title">
        <div></div>
        <h3>患者基本情况</h3>
      </div>
      <div class="gr4-1">
        <div class="qk">
          <div class="qk-left">
            <span>病例号:</span><span class="bt">*</span>
          </div>
          <div class="qk-right">
            <input
              type="text"
              class="ipt1"
              placeholder="请输入准确的病历号后回车(门诊就诊卡号)"
            />
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>病人信息:</span>
          </div>
          <div class="qk-right">
            <span>姓名</span>
            <input type="text" class="xb" />
            <span>性别</span>
            <select name="" class="xb">
              <option value="">男</option>
              <option value="">女</option>
            </select>
            <span>年龄</span>
            <input type="text" class="xb" />
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>所在科室:</span>
          </div>
          <div class="qk-right">
            <select name="" style="width: 100%">
              <option value="">妇科</option>
              <option value="">内分泌科</option>
              <option value="">儿童心理科</option>
              <option value="">儿科</option>
              <option value="">产科</option>
              <option value="">神经外科</option>
              <option value="">眼科</option>
            </select>
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>入院日期:</span><span class="bt">*</span>
          </div>
          <div class="qk-right"><input type="date" class="ipt1" /></div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>临床诊断:</span>
          </div>
          <div class="qk-right">
            <input type="text" class="ipt1" style="height: 90px" />
          </div>
        </div>
      </div>
      <div class="title">
        <div></div>
        <h3>事件基本情况</h3>
      </div>
      <div class="gr4-1">
        <div class="qk">
          <div class="qk-left">
            <span>报告日期:</span><span class="bt">*</span>
          </div>
          <div class="qk-right">
            <input
              type="date"
              class="ipt1"
              placeholder="请输入准确的病历号后回车(门诊就诊卡号)"
            />
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>是否匿名上报:</span><span class="bt">*</span>
          </div>
          <div class="qk-right">
            <div class="cds">
              <div class="xb"><input type="radio" /> <span>否</span></div>
              <div class="xb"><input type="radio" /> <span>是</span></div>
            </div>
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>事件发生的场所:</span><span class="bt">*</span>
          </div>
          <div style="width: 540px">
            <div class="cds">
              <div class="xb"><input type="radio" /> <span>门诊</span></div>
              <div class="xb"><input type="radio" /> <span>急诊</span></div>
              <div class="xb"><input type="radio" /> <span>住院</span></div>
            </div>
            <div class="cds">
              <div class="xb"><input type="radio" /> <span>手术麻醉</span></div>
              <div class="xb"><input type="radio" /> <span>产房</span></div>
              <div class="xb"><input type="radio" /> <span>一技科室</span></div>
            </div>
            <div class="cds">
              <div class="xb">
                <input type="radio" /> <span>公共活动区域</span>
              </div>
              <div class="xb"><input type="radio" /> <span>场所不明</span></div>
              <div class="xb"><input type="radio" /> <span>其他场所</span></div>
            </div>
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <p>给患者造成损害的轻重程度:</p>
          </div>
          <div style="width: 540px">
            <h3>Ⅰ级：发生错误，造成患者死亡</h3>
            <div style="width: 100%">
              <input type="radio" /> <span>I级：导致患者死亡</span>
            </div>
            <h3>Ⅱ级：发生错误，且造成患者伤害</h3>
            <div style="width: 100%">
              <input type="radio" />
              <span>E级：造成患者暂时性伤害，并需要进行治疗或干预</span>
            </div>
            <div style="width: 100%">
              <input type="radio" />
              <span>F级：造成患者暂时性伤害，并需要住院或延长住院时间</span>
            </div>
            <div style="width: 100%">
              <input type="radio" /> <span>G级：造成患者永久性伤害</span>
            </div>
            <div style="width: 100%">
              <input type="radio" /> <span>H级：导致患者需要治疗挽救生命</span>
            </div>
            <h3>Ⅲ级：发生错误，但未造成患者伤害</h3>
            <div style="width: 100%">
              <input type="radio" /> <span>B级：发生但未累及患者</span>
            </div>
            <div style="width: 100%">
              <input type="radio" />
              <span>C级：累及到患者，但没有造成伤害</span>
            </div>
            <div style="width: 100%">
              <input type="radio" />
              <span
                >D级：累及到患者，需要进行监测以确保患者不被伤害，或需通过干预阻止伤害发生</span
              >
            </div>
            <h3>Ⅳ级：错误未发生（错误隐患）</h3>
            <div style="width: 100%">
              <input type="radio" />
              <span>A级：客观环境或条件可能引发不良事件（隐患）</span>
            </div>

            <h3>
              警讯事件：<span style="font-size: 14px"
                >涉及死亡或严重身体伤害或心理伤害的意外事件。严重身体伤害具体包括丧失四肢或功能。</span
              >
            </h3>
            <h3>
              不良后果事件：<span style="font-size: 14px"
                >造成机体或功能的损害的事件。

                </span
              >
            </h3>
            <h3>
              未造成后果事件：<span style="font-size: 14px"
                >虽然发生了错误事实，但未造成不良后果。</span
              >
            </h3>
            <h3>
              临界差错事件：<span style="font-size: 14px"
                >任何发现的缺陷或错误，未形成事实，未造成危害，但其再发生很有可能带来严重后果。</span
              >
            </h3>
          </div>
        </div>
      </div>
      <div class="title">
        <div></div>
        <h3>感染病例报告卡</h3>
      </div>
      <div class="gr4-1">
        <div class="qk">
          <div class="qk-left">
            <span>感染日期:</span><span class="bt">*</span>
          </div>
          <div class="qk-right">
            <input
              type="date"
              class="ipt1"
            />
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>病房类型:</span><span class="bt">*</span>
          </div>
          <div class="qk-right">
            <div class="cds">
              <div class="xb"><input type="radio" /> <span>普通病房</span></div>
              <div class="xb"><input type="radio" /> <span>ICU病房</span></div>
            </div>
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>感染诊断:</span>
          </div>
          <div class="qk-right">
            <input type="text" class="ipt1" style="height: 90px" />
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>病原体检查:</span>
          </div>
          <div class="qk-right">
            <div class="cds">
              <div class="xb"><input type="radio" /> <span>否</span></div>
              <div class="xb"><input type="radio" /> <span>是</span></div>
            </div>
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>标本名称:</span>
          </div>
          <div class="qk-right">
            <input type="text" class="ipt1"/>
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>病原体详解:</span>
          </div>
          <div class="qk-right">
            <input type="text" class="ipt1" style="height: 90px" />
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>易感因素：(可多选):</span><span class="bt">*</span>
          </div>
          <div style="width: 540px">
            <div class="cds">
              <div class="xb"><input type="checkbox" /> <span>糖尿病</span></div>
              <div class="xb"><input type="checkbox" /> <span>泌尿道插管</span></div>
              <div class="xb"><input type="checkbox" /> <span>抗生素</span></div>
            </div>
            <div class="cds">
              <div class="xb"><input type="checkbox" /> <span>动静脉插管</span></div>
              <div class="xb"><input type="checkbox" /> <span>肝硬化</span></div>
              <div class="xb"><input type="checkbox" /> <span>使用呼吸机</span></div>
            </div>
            <div class="cds">
              <div class="xb">
                <input type="checkbox" /> <span>药瘾者</span>
              </div>
              <div class="xb"><input type="checkbox" /> <span>人工装置</span></div>
              <div class="xb"><input type="checkbox" /> <span>放疗</span></div>
            </div>
            <div class="cds">
              <div class="xb"><input type="checkbox" /> <span>引流管</span></div>
              <div class="xb"><input type="checkbox" /> <span>化疗</span></div>
              <div class="xb"><input type="checkbox" /> <span>手术</span></div>
            </div>
            <div class="cds">
              <div class="xb"><input type="checkbox" /> <span>免疫抑制剂</span></div>
              <div class="xb"><input type="checkbox" /> <span>肿瘤</span></div>
              <div class="xb"><input type="checkbox" /> <span>营养不良</span></div>
            </div>
            <div class="cds">
              <div class="xb"><input type="checkbox" /> <span style="font-size: 10px;">WBC计数< 1.5x109/L</span></div>
              <div class="xb"><input type="checkbox" /> <span>其他</span></div>
            </div>
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>备注:</span>
          </div>
          <div class="qk-right">
            <input type="text" class="ipt1" style="height: 90px" />
          </div>
        </div>
      </div>
      <div class="title">
        <div></div>
        <h3>报告者基本情况</h3>
      </div>
      <div class="gr4-1">
        <div class="qk">
          <div class="qk-left">
            <span>报告人信息:</span>
          </div>
          <div class="qk-right">
            <span>姓名</span><span class="bt2">*</span>
            <input type="text" class="xb" />
            <span>科室</span><span class="bt2">*</span>
            <select name="" class="xb">
              <option value="">妇科</option>
              <option value="">内分泌科</option>
              <option value="">儿童心理科</option>
              <option value="">儿科</option>
              <option value="">产科</option>
              <option value="">神经外科</option>
              <option value="">眼科</option>
            </select>
            <span>年龄</span><span class="bt2">*</span>
            <select name="" class="xb">
              <option value="">---请选择---</option>
              <option value="">初级</option>
              <option value="">中级</option>
              <option value="">副高</option>
              <option value="">高级</option>
              <option value="">无</option>
            </select>
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>联系信息:</span>
          </div>
          <div>
            <div style="height: 35px;margin-bottom: 20px;" class="qk-right">
              <span>联系电话</span><span class="bt2">*</span>
              <input type="text" class="xb" style="width: 200px;" />
              <span>职业</span><span class="bt2">*</span>
              <input type="radio" />
              <span>医师</span>
              <input type="radio" />
              <span>药师</span>
              <input type="radio" />
              <span>护士</span>
              <input type="radio" />
              <span>其他</span>
            </div>
            <div style="height: 35px;" class="qk-right">
              <span>电子邮箱</span><span class="bt2">*</span>
              <input type="text" class="xb" style="width: 200px;" />
              <span>签名</span><span class="bt2">*</span>
              <input type="text" class="xb" style="width: 200px;"/>
            </div>
          </div>
        </div>
        <div class="qk">
          <div class="qk-left">
            <span>单位信息:</span>
          </div>
          <div>
            <div style="height: 35px;margin-bottom: 20px;" class="qk-right">
              <span>单位名称</span>
              <input type="text" class="xb" style="width: 200px;" />
              <span>联系人</span>
              <input type="text" class="xb" style="width: 200px;" />
            </div>
            <div style="height: 35px;" class="qk-right">
              <span>电话</span>
              <input type="text" class="xb" style="width: 200px;" />
              <span>报告日期</span>
              <input type="date" class="xb" style="width: 200px;"/>
            </div>
          </div>
        </div>
        <div class="tjj">
          <button id="j1">确定提交</button>
          <button id="j2">暂存数据</button>
        </div>
      </div>
      
    </div>
  </body>
</html>
